Get rid of your white facial and body hair with the FUE method

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Leukotrichia is an acquired depigmentation hair disorder that can evolve potentially at any given part of the hair-covered body surface with sites of predilection being the scalp, beard, neck, chest and genital area. Leukotrichia can be a psychosocially disfiguring condition with major impact on the individual’s psychosynthesis, as it is usually connected with old age & increased stress. A number of treatment modalities have been tried such as laserhair removal, epilation, radiofrequencies (RF) but, in the majority of cases, they have been proven of little, if any, significance. As a matter of fact, laser hair removal, while proven the method of choice for permanent removal of dark hair, has very limited effectiveness in the permanent removal of white hair. Leukotrichia constitutes a quite common aesthetic problem for both men & women.

Follicular unit extraction (FUE) isa minimally invasive surgical procedure that utilizes a punch device to harvestfollicularunits (FU) and is a widely accepted technique for transplanting bald areas in order to restore hair growth. In addition, FUE has been applied successfully for harvesting follicular units from other hair-bearing areas of the body, such as facial hair (e.g. beard) or body hair (e.g. chest). The cumulative experience in the successful application of FUE in other areas of the body has led to the hypothesis that FUE can be used by experienced teams as a method of permanent hair removal of undesired white hairs from various areas of the body.

Objectives:
Toevaluate the efficacy of FUE as an enduring treatment option for leukotrichia and furthermore assess the complete cure rate defined as the absence of re-growth within a follow-up period of 3 months.

Material and Methods:
32 enrolled patients underwent FUE for leukotrichia. Patients were recruited from a private dermatology & plastic surgery clinic setting. Inclusion criteria: presence of undesired white hair at any involved part of the body. Exclusion criteria: pregnancy or lactation, bleeding diathesis, active cutaneous infection. FUE was performed using a motorized punch holder with a hollow sharp punch of 0.75-0.9 mm, depending on the involved skin area. Smaller caliber punches were used on the face, while bigger punches were used on the thighs or the genital area. The punch was to incise the skin around the FU from the surrounding tissue, with the purpose of extracting a full hair follicle rather than a transected one. Previous experience has shown that partially transected hair follicles tend to regrow. The isolated FU was then extracted from its bed with the use of curved jeweller’s forceps. Complete cure rate was assessed with the use of digital photography, before and after FUE treatment. Follow up of patients was done in one week & three months after the initial session, in order to estimate the existence of early (bleeding, bruising, local infection) or late (visible scarring, hyper/hypopigmentation) side effects, as well as the effectiveness of the treatment in terms of white hair regrowth & patient satisfaction.

Results:

In the study participated 8 males & 24 females with a mean age of 51. All patients were of Caucasian ancestry, Fitzpatrick classification phototypes I-IV. Involvement of the face was in 15 cases, 9 was the beard, and 5 were the neck and 3 in the genital area. In all 32 enrolled patients, complete extraction of intact follicular units was achieved. 18 out of 32 patients accomplished complete cure rate after the first session. Recorded side effects were: minimal bleeding during extraction (5 patients, 15.6%), bruising (4 patients,12.5%). No localized infection was recorded nor any late side effects such as permanent scarring or hyper/hypopigmentation. Patients’ satisfaction was as high as 87.5% (28 out of 32 patients). More than one session of FUE white hair removal was needed in 14 out of 32 cases, (56.25%).

Conclusions:
Our results support findings that FUE captures the benefit of complete follicular unit extraction with minimal re-growth rate in leukotrichia hairs. This technique can serve as an important mainstay treatment option for permanent whitehair removal. Limited areas of leukotrichia involvement were addressed successfully with a single session while repeated sessions were required to address more extensive areas. Permanent white hair removal took place without any significant side effects (scarring or hyper/hypopigmentation). As the population of the patients was of Caucasian background, further studies are required to address the issue of potential long term side effects, as scarring or hyper/hypopigmentation in other populations of darker phototypes. Furthermore, it is evident from previous studies that partially transected hair follicles tend to regrow. Thus, it is of outmost importance that FUE white hair removal needs to take place under optimal conditions in order to provide fully intact follicular units in order to minimize the potential regrowth. In the hands of experienced FUE teams, follicular unit extraction may provide a solid solution for the permanent treatment of leucotrichia, where other treatments fail to provide trustworthy solutions.

Presented at the 22nd Annual ISHRS Scientific Meeting, October 11th 2014, Kuala Lumpur, Malaysia.
Article by
Greece Plastic Surgeon